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Thrombomodulin is associated with increased mortality and organ failure in mechanically ventilated children with acute respiratory failure: biomarker analysis from a multicenter randomized controlled trial
Ana Carolina Costa Monteiro, Heidi Flori, Mary K. Dahmer, Myung Shin Sim, Michael W. Quasney, Martha A. Q. Curley, Michael A. Matthay & Anil Sapru for the BALI Study Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
doi : 10.1186/s13054-021-03626-1
Critical Care volume 25, Article number: 271 (2021)
Acute respiratory failure (ARF) can progress to acute respiratory distress syndrome and death. Biomarkers may allow for risk stratification and prognostic enrichment in ARF. Thrombomodulin (TM) is a transmembrane antithrombotic mediator expressed in endothelial cells. It is cleaved into its soluble form (sTM) during inflammation and vascular injury. Levels of sTM correlate with inflammation and end organ dysfunction.
Correction to: Effects of early extubation followed by noninvasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in hypoxemic non-hypercapnic patients: a systematic review and individual patient data meta-analysis of randomized controlled trials
Rosanna Vaschetto, Alessandro Pecere, Gavin D. Perkins, Dipesh Mistry, Gianmaria Cammarota, Federico Longhini, Miguel Ferrer, Renata Pletsch-Assunç?o, Michele Carron, Francesca Moretto, Haibo Qiu, Francesco Della Corte, Francesco Barone-Adesi & Paolo Navalesi
doi : 10.1186/s13054-021-03692-5
Critical Care volume 25, Article number: 272 (2021)
Letter to the Editor in response to “Find the real responders and improve the outcome of awake prone positioning”
Jacob Rosén, Erik von Oelreich, Diddi Fors, Malin Jonsson Fagerlund , Knut Taxbro & Peter Frykholm
doi : 10.1186/s13054-021-03707-1
Critical Care volume 25, Article number: 273 (2021)
Interleukin-34: an important modifier in the pathogenesis of influenza pneumonia
Banglao Xu, Xue Lin, Yi Gong, Xiaofei Lai, Lei Ren & Ju Cao
doi : 10.1186/s13054-021-03708-0
Critical Care volume 25, Article number: 274 (2021)
Targeted temperature management and cardiac arrest after the TTM-2 study
Fabio Silvio Taccone, Jean-Baptiste Lascarrou & Markus B. Skrifvars
doi : 10.1186/s13054-021-03718-y
Critical Care volume 25, Article number: 275 (2021)
A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography
Mariangela Pellegrini, Aleksandra Larina, Evangelos Mourtos, Robert Frithiof, Miklos Lipcsey, Michael Hultstr?m, Monica Segelsj?, Tomas Hansen & Gaetano Perchiazzi
doi : 10.1186/s13054-021-03685-4
Critical Care volume 25, Article number: 276 (2021)
Typical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression.
The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®
Sebastian Imach, Arasch Wafaisade, Rolf Lefering, Andreas B?hmer, Mark Schieren, Victor Su?rez, Matthias Fr?hlich & TraumaRegister DGU
doi : 10.1186/s13054-021-03701-7
Critical Care volume 25, Article number: 277 (2021)
Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany.
Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients
Emma J. Kooistra, Miranda van Berkel, Noortje F. van Kempen, Celine R. M. van Latum, Niklas Bruse, Tim Frenzel, Maarten J. W. van den Berg, Jeroen A. Schouten, Matthijs Kox & Peter Pickkers
doi : 10.1186/s13054-021-03717-z
Critical Care volume 25, Article number: 281 (2021)
Procalcitonin (PCT) and C-reactive protein (CRP) were previously shown to have value for the detection of secondary infections in critically ill COVID-19 patients. However, since the introduction of immunomodulatory therapy, the value of these biomarkers is unclear. We investigated PCT and CRP kinetics in critically ill COVID-19 patients treated with dexamethasone with or without tocilizumab, and assessed the value of these biomarkers to detect secondary bacterial infections.
Association of cerebrospinal fluid protein biomarkers with outcomes in patients with traumatic and non-traumatic acute brain injury: systematic review of the literature
Carlos A. Santacruz, Jean-Louis Vincent, Andres Bader, Luis A. Rinc?n-Gutiérrez, Claudia Dominguez-Curell, David Communi & Fabio S. Taccone
doi : 10.1186/s13054-021-03698-z
Critical Care volume 25, Article number: 278 (2021)
Acute brain injuries are associated with high mortality rates and poor long-term functional outcomes. Measurement of cerebrospinal fluid (CSF) biomarkers in patients with acute brain injuries may help elucidate some of the pathophysiological pathways involved in the prognosis of these patients.
Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study
Mel E. Major, Daniela Dettling-Ihnenfeldt, Stephan P. J. Ramaekers, Raoul H. H. Engelbert & Marike van der Schaaf
doi : 10.1186/s13054-021-03709-z
Critical Care volume 25, Article number: 279 (2021)
Survivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home.
Breathing variability—implications for anaesthesiology and intensive care
Oscar F. C. van den Bosch, Ricardo Alvarez-Jimenez, Harm-Jan de Grooth, Armand R. J. Girbes & Stephan A. Loer
doi : 10.1186/s13054-021-03716-0
Critical Care volume 25, Article number: 280 (2021)
The respiratory system reacts instantaneously to intrinsic and extrinsic inputs. This adaptability results in significant fluctuations in breathing parameters, such as respiratory rate, tidal volume, and inspiratory flow profiles. Breathing variability is influenced by several conditions, including sleep, various pulmonary diseases, hypoxia, and anxiety disorders. Recent studies have suggested that weaning failure during mechanical ventilation may be predicted by low respiratory variability. This review describes methods for quantifying breathing variability, summarises the conditions and comorbidities that affect breathing variability, and discusses the potential implications of breathing variability for anaesthesia and intensive care.
Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement
Siew Tzuh Tang, Chung-Chi Huang, Tsung-Hui Hu, Wen-Chi Chou, Li-Pang Chuang & Ming Chu Chiang
doi : 10.1186/s13054-021-03719-x
Critical Care volume 25, Article number: 282 (2021)
Death in intensive care units (ICUs) may increase bereaved family members’ risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care.
Association of intensity of ventilation with 28-day mortality in COVID-19 patients with acute respiratory failure: insights from the PRoVENT-COVID study
Michiel T. U. Schuijt, Marcus J. Schultz, Frederique Paulus & Ary Serpa Neto for the PRoVENT–COVID Collaborative Group
doi : 10.1186/s13054-021-03710-6
Critical Care volume 25, Article number: 283 (2021)
The intensity of ventilation, reflected by driving pressure (?P) and mechanical power (MP), has an association with outcome in invasively ventilated patients with or without acute respiratory distress syndrome (ARDS). It is uncertain if a similar association exists in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure.
Correction to: Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort
Saad Nseir, Ignacio Martin-Loeches, Pedro Povoa, Matthieu Metzelard, Damien Du Cheyron, Fabien Lambiotte, Fabienne Tamion, Marie Labruyere, Demosthenes Makris, Claire Boulle Geronimi, Marc Pinetonde Chambrun, Martine Nyunga, Olivier Pouly, Bruno Mégarbane, Anastasia Saade, Gemma Gomà, Eleni Magira, Jean-François Llitjos, Antoni Torres, Iliana Ioannidou, Alexandre Pierre, Luis Coelho, Jean Reignier, Denis Garot, Louis Kreitmann, Jean-Luc Baudel, Guillaume Voiriot, Damien Contou, Alexandra Beurton, Pierre Asfar, Alexandre Boyer, Arnaud W. Thille, Armand Mekontso-Dessap, Vassiliki Tsolaki, Christophe Vinsonneau, Pierre-Edouard Floch, Loïc Le Guennec, Adrian Ceccato, Antonio Artigas, Mathilde Bouchereau, Julien Labreuche, Alain Duhamel, Anahita Rouzé & the coVAPid study group-Show fewer authors
doi : 10.1186/s13054-021-03713-3
Critical Care volume 25, Article number: 284 (2021)
VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11–2.46), p?=?0.013), but not in influenza (1.74 (0.99–3.06), p?=?0.052), or no viral infection groups (1.13 (0.68–1.86), p?=?0.63).
Letter to the editor regarding Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis
Dominik Johannes Hoechter, Andrea Sabine Becker-Pennrich, Benjamin Peter Geisler, Bernhard Zwissler, Michael Irlbeck, Kollengode Ramanathan, Kiran Shekar, Ryan Ruiyang Ling, Ryan Barbaro, Graeme MacLaren, Eddy Fan & Daniel Brodie
doi : 10.1186/s13054-021-03702-6
Critical Care volume 25, Article number: 285 (2021)
Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa
Jing Zhou, Tianbing Wang, Igor Belenkiy, Timothy Craig Hardcastle, Jean-Jacques Rouby & Baoguo Jiang for the International Trauma Rescue & Treatment Association (ITRTA) Study Group
doi : 10.1186/s13054-021-03681-8
Critical Care volume 25, Article number: 286 (2021)
As emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.
Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment
Matthew H. Anstey, Imogen A. Mitchell, Charlie Corke, Lauren Murray, Marion Mitchell, Andrew Udy, Vineet Sarode, Nhi Nguyen, Oliver Flower, Kwok M. Ho, Edward Litton, Bradley Wibrow & Richard Norman
doi : 10.1186/s13054-021-03712-4
Critical Care volume 25, Article number: 287 (2021)
To test the hypothesis that Intensive Care Unit (ICU) doctors and nurses differ in their personal preferences for treatment from the general population, and whether doctors and nurses make different choices when thinking about themselves, as compared to when they are treating a patient.
Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care
Junzi Dong, Ting Feng, Binod Thapa-Chhetry, Byung Gu Cho, Tunu Shum, David P. Inwald, Christopher J. L. Newth & Vinay U. Vaidya
doi : 10.1186/s13054-021-03724-0
Critical Care volume 25, Article number: 288 (2021)
Acute kidney injury (AKI) in pediatric critical care patients is diagnosed using elevated serum creatinine, which occurs only after kidney impairment. There are no treatments other than supportive care for AKI once it has developed, so it is important to identify patients at risk to prevent injury. This study develops a machine learning model to learn pre-disease patterns of physiological measurements and predict pediatric AKI up to 48 h earlier than the currently established diagnostic guidelines.
Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: a subgroup analysis of the DOREMI trial
Pietro Di Santo, Rebecca Mathew, Richard G. Jung, Trevor Simard, Stephanie Skanes, Brennan Mao, F. Daniel Ramirez, Jeffrey A. Marbach, Omar Abdel-Razek, Pouya Motazedian, Simon Parlow, Kevin E. Boczar, Gianni D’Egidio, Steven Hawken, Jordan Bernick, George A. Wells, Alexander Dick, Derek Y. So, Christopher Glover, Juan J. Russo, Caroline McGuinty, Benjamin Hibbert on behalf of the CAPITAL DOREMI investigators
doi : 10.1186/s13054-021-03706-2
Critical Care volume 25, Article number: 289 (2021)
Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS.
Ceftolozane/tazobactam versus meropenem in patients with ventilated hospital-acquired bacterial pneumonia: subset analysis of the ASPECT-NP randomized, controlled phase 3 trial
Jean-François Timsit, Jennifer A. Huntington, Richard G. Wunderink, Nobuaki Shime, Marin H. Kollef, ?lo Kivistik, Martin Nov??ek, ?lvaro Réa-Neto, Ignacio Martin-Loeches, Brian Yu, Erin H. Jensen, Joan R. Butterton, Dominik J. Wolf, Elizabeth G. Rhee & Christopher J. Bruno
doi : 10.1186/s13054-021-03694-3
Critical Care volume 25, Article number: 290 (2021)
Ceftolozane/tazobactam is approved for treatment of hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) at double the dose approved for other infection sites. Among nosocomial pneumonia subtypes, ventilated HABP (vHABP) is associated with the lowest survival. In the ASPECT-NP randomized, controlled trial, participants with vHABP treated with ceftolozane/tazobactam had lower 28-day all-cause mortality (ACM) than those receiving meropenem. We conducted a series of post hoc analyses to explore the clinical significance of this finding.
Cerebrospinal fluid cell count variability is a major confounding factor in external ventricular drain-associated infection surveillance diagnostics: a prospective observational study
Marcus B?dholm, Jonas Blixt, Martin Glim?ker, Anders Ternhag, Jonas Hedlund & David W. Nelson
doi : 10.1186/s13054-021-03715-1
Critical Care volume 25, Article number: 291 (2021)
External ventricular drain (EVD)-related infections (EVDIs) are feared complications that are difficult to rapidly and correctly diagnose, which can lead to unnecessary treatment with broad-spectrum antibiotics. No readily available diagnostic parameters have been identified to reliably predict or identify EVDIs. Moreover, intraventricular hemorrhage is common and affect cerebrospinal fluid (CSF) cellularity. The relationship between leukocytes and erythrocytes is often used to identify suspected infection and triggers the use of antibiotics pending results of cultures, which may take days. Cell count based surveillance diagnostics assumes a homogeneous distribution of cells in the CSF. Given the intraventricular sedimentation of erythrocytes on computed tomography scans this assumption may be erroneous and could affect diagnostics.
Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis
Wynne Hsing Poon, Kollengode Ramanathan, Ryan Ruiyang Ling, Isabelle Xiaorui Yang, Chuen Seng Tan, Matthieu Schmidt & Kiran Shekar
doi : 10.1186/s13054-021-03723-1
Critical Care volume 25, Article number: 292 (2021)
Prone positioning (PP) improves oxygenation and respiratory mechanics and is associated with lower mortality in patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite this, some patients develop refractory hypoxemia and hypercapnia requiring venovenous extracorporeal membrane oxygenation (VV ECMO) support and are usually cared for in supine position. The physiologic and outcome benefits of routine PP of patients during VV ECMO remains unclear. Hence, we conducted the systematic review and meta-analysis to evaluate the outcome benefits of PP for patients with ARDS being treated with VV ECMO.
Comparison of culture?negative and culture?positive sepsis or septic shock: outcomes are more influenced by the nature of the infectious agent itself than by the samples’ positivity
Romain Jouffroy & Benoît Vivien
doi : 10.1186/s13054-021-03651-0
Critical Care volume 25, Article number: 293 (2021)
Serum renin and major adverse kidney events in critically ill patients: a multicenter prospective study
Alexander H. Flannery, Victor Ortiz-Soriano, Xilong Li, Fabiola G. Gianella, Robert D. Toto, Orson W. Moe, Prasad Devarajan, Stuart L. Goldstein & Javier A. Neyra
doi : 10.1186/s13054-021-03725-z
Critical Care volume 25, Article number: 294 (2021)
Preliminary studies have suggested that the renin-angiotensin system is activated in critical illness and associated with mortality and kidney outcomes. We sought to assess in a larger, multicenter study the relationship between serum renin and Major Adverse Kidney Events (MAKE) in intensive care unit (ICU) patients.
Machine learning identifies ICU outcome predictors in a multicenter COVID-19 cohort
Harry Magunia, Simone Lederer, Raphael Verbuecheln, Bryant Joseph Gilot, Michael Koeppen, Helene A. Haeberle, Valbona Mirakaj, Pascal Hofmann, Gernot Marx, Johannes Bickenbach, Boris Nohe, Michael Lay, Claudia Spies, Andreas Edel, Fridtjof Schiefenh?vel, Tim Rahmel, Christian Putensen, Timur Sellmann, Thea Koch, Timo Brandenburger, Detlef Kindgen-Milles, Thorsten Brenner, Marc Berger, Kai Zacharowski, Elisabeth Adam, Matthias Posch, Onnen Moerer, Christian S. Scheer, Daniel Sedding, Markus A. Weigand, Falk Fichtner, Carla Nau, Florian Pr?tsch, Thomas Wiesmann, Christian Koch, Gerhard Schneider, Tobias Lahmer, Andreas Straub, Andreas Meiser, Manfred Weiss, Bettina Jungwirth, Frank Wappler, Patrick Meybohm, Johannes Herrmann, Nisar Malek, Oliver Kohlbacher, Stephanie Biergans & Peter Rosenberger -Show fewer authors
doi : 10.1186/s13054-021-03720-4
Critical Care volume 25, Article number: 295 (2021)
Intensive Care Resources are heavily utilized during the COVID-19 pandemic. However, risk stratification and prediction of SARS-CoV-2 patient clinical outcomes upon ICU admission remain inadequate. This study aimed to develop a machine learning model, based on retrospective & prospective clinical data, to stratify patient risk and predict ICU survival and outcomes.
Cholesterol and its association with muscle weakness in critical illness
Daniel A. Hofmaenner, Anna Kleyman & Mervyn Singer
doi : 10.1186/s13054-021-03722-2
Critical Care volume 25, Article number: 296 (2021)
Corticosteroids and RCTs against the supposed undervaluation of real data evidence
Alejandro Rodr?guez, Gerard Moreno, Maria Bodi, Josep Gomez & Ignacio Mart?n-Loeches
doi : 10.1186/s13054-021-03721-3
Critical Care volume 25, Article number: 297 (2021)
Inhaled liposomal amphotericin-B as a prophylactic treatment for COVID-19-associated pulmonary aspergillosis/aspergillus tracheobronchitis
Sofie Van Ackerbroeck, Lynn Rutsaert, Ella Roelant, Kathleen Dillen, Joost Wauters & Niels Van Regenmortel
doi : 10.1186/s13054-021-03728-w
Critical Care volume 25, Article number: 298 (2021)
Continuous renal replacement therapy in COVID-19—associated AKI: adding heparin to citrate to extend filter life—a retrospective cohort study
Eduardo de Oliveira Valle, Carla Paulina Sandoval Cabrera, Claudia Coimbra César de Albuquerque, Giovanio Vieira da Silva, M?rcia Fernanda Arantes de Oliveira, Gabriel Teixeira Montezuma Sales, Igor Smolentzov, Bernardo Vergara Reichert, Lucia Andrade, Victor Faria Seabra, Paulo Ricardo Gessolo Lins & Camila Eleuterio Rodrigues
doi : 10.1186/s13054-021-03729-9
Critical Care volume 25, Article number: 299 (2021)
Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic events. The best anticoagulation strategy for continuous renal replacement therapy (CRRT) in such patients is still under debate. The purpose of this study was to evaluate the impact that different anticoagulation protocols have on filter clotting risk.
Elevated HbA1c remains a predominant finding in severe COVID-19 and may be associated with increased mortality in patients requiring mechanical ventilation
Sebastian J. Klein, Timo Mayerh?fer, Dietmar Fries, Christian Preu? Hern?ndez, Michael Joannidis & Collaborators
doi : 10.1186/s13054-021-03730-2
Critical Care volume 25, Article number: 300 (2021)
Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
Gaud Catho, R. Martischang, F. Boroli, M. N. Chraïti, Y. Martin, Z. Koyluk Tomsuk, G. Renzi, J. Schrenzel, J. Pugin, P. Nordmann, D. S. Blanc & S. Harbarth
doi : 10.1186/s13054-021-03726-y
Critical Care volume 25, Article number: 301 (2021)
Long-term outbreaks of multidrug-resistant Gram-negative bacilli related to hospital-building water systems have been described. However, successful mitigation strategies have rarely been reported. In particular, environmental disinfection or replacement of contaminated equipment usually failed to eradicate environmental sources of Pseudomonas aeruginosa.
Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock
Imane Adda, Christopher Lai, Jean-Louis Teboul, Laurent Guerin, Francesco Gavelli & Xavier Monnet
doi : 10.1186/s13054-021-03711-5
Critical Care volume 25, Article number: 302 (2021)
Through venous contraction, norepinephrine (NE) increases stressed blood volume and mean systemic pressure (Pms) and exerts a “fluid-like” effect. When both fluid and NE are administered, Pms may not only result from the sum of the effects of both drugs. Indeed, norepinephrine may enhance the effects of volume expansion: because fluid dilutes into a more constricted, smaller, venous network, fluid may increase Pms to a larger extent at a higher than at a lower dose of NE. We tested this hypothesis, by mimicking the effects of fluid by passive leg raising (PLR).
Electrical impedance tomography captures heterogeneous lung ventilation that may be associated with ineffective inspiratory efforts
Qing Pan, Mengzhe Jia, Huiqing Ge & Zhanqi Zhao
doi : 10.1186/s13054-021-03732-0
Critical Care volume 25, Article number: 303 (2021)
The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients
Lucas M. Fleuren, Tariq A. Dam, Michele Tonutti, Daan P. de Bruin, Robbert C. A. Lalisang, Diederik Gommers, Olaf L. Cremer, Rob J. Bosman, Sander Rigter, Evert-Jan Wils, Tim Frenzel, Dave A. Dongelmans, Remko de Jong, Marco Peters, Marlijn J. A. Kamps, Dharmanand Ramnarain, Ralph Nowitzky, Fleur G. C. A. Nooteboom, Wouter de Ruijter, Louise C. Urlings-Strop, Ellen G. M. Smit, D. Jannet Mehagnoul-Schipper, Tom Dormans, Cornelis P. C. de Jager, Stefaan H. A. Hendriks, Sefanja Achterberg, Evelien Oostdijk, Auke C. Reidinga, Barbara Festen-Spanjer, Gert B. Brunnekreef, Alexander D. Cornet, Walter van den Tempel, Age D. Boelens, Peter Koetsier, Judith Lens, Harald J. Faber, A. Karakus, Robert Entjes, Paul de Jong, Thijs C. D. Rettig, Sesmu Arbous, Sebastiaan J. J. Vonk, Mattia Fornasa, Tomas Machado, Taco Houwert, Hidde Hovenkamp, Roberto Noorduijn-Londono, Davide Quintarelli, Martijn G. Scholtemeijer, Aletta A. de Beer, Giovanni Cina, Martijn Beudel, Willem E. Herter, Armand R. J. Girbes, Mark Hoogendoorn, Patrck J. Thoral & Paul W. G. Elbers -Show fewer authors
doi : 10.1186/s13054-021-03733-z
Critical Care volume 25, Article number: 304 (2021)
The Coronavirus disease 2019 (COVID-19) pandemic has underlined the urgent need for reliable, multicenter, and full-admission intensive care data to advance our understanding of the course of the disease and investigate potential treatment strategies. In this study, we present the Dutch Data Warehouse (DDW), the first multicenter electronic health record (EHR) database with full-admission data from critically ill COVID-19 patients.
Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease
Gianmaria Cammarota, Elisa Rossi, Leonardo Vitali, Rachele Simonte, Tiziano Sannipoli, Francesco Anniciello, Luigi Vetrugno, Elena Bignami, Cecilia Becattini, Simonetta Tesoro, Danila Azzolina, Angelo Giacomucci, Paolo Navalesi & Edoardo De Robertis
doi : 10.1186/s13054-021-03735-x
Critical Care volume 25, Article number: 305 (2021)
Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV.
Role of endothelial miR-24 in COVID-19 cerebrovascular events
Jessica Gambardella, Antonietta Coppola, Raffaele Izzo, Giuseppe Fiorentino, Bruno Trimarco & Gaetano Santulli
doi : 10.1186/s13054-021-03731-1
Critical Care volume 25, Article number: 306 (2021)
Initial antimicrobial management of sepsis
Michael S. Niederman, Rebecca M. Baron, Lila Bouadma, Thierry Calandra, Nick Daneman, Jan DeWaele, Marin H. Kollef, Jeffrey Lipman & Girish B. Nair
doi : 10.1186/s13054-021-03736-w
Critical Care volume 25, Article number: 307 (2021)
Sepsis is a common consequence of infection, associated with a mortality rate?>?25%. Although community-acquired sepsis is more common, hospital-acquired infection is more lethal. The most common site of infection is the lung, followed by abdominal infection, catheter-associated blood steam infection and urinary tract infection. Gram-negative sepsis is more common than gram-positive infection, but sepsis can also be due to fungal and viral pathogens. To reduce mortality, it is necessary to give immediate, empiric, broad-spectrum therapy to those with severe sepsis and/or shock, but this approach can drive antimicrobial overuse and resistance and should be accompanied by a commitment to de-escalation and antimicrobial stewardship. Biomarkers such a procalcitonin can provide decision support for antibiotic use, and may identify patients with a low likelihood of infection, and in some settings, can guide duration of antibiotic therapy. Sepsis can involve drug-resistant pathogens, and this often necessitates consideration of newer antimicrobial agents.
A randomized controlled trial to determine whether beta-hydroxy-beta-methylbutyrate and/or eicosapentaenoic acid improves diaphragm and quadriceps strength in critically Ill mechanically ventilated patients
Gerald S. Supinski, Paul F. Netzel, Philip M. Westgate, Elizabeth A. Schroder, Lin Wang & Leigh Ann Callahan
doi : 10.1186/s13054-021-03737-9
Critical Care volume 25, Article number: 308 (2021)
Intensive care unit acquired weakness is a serious problem, contributing to respiratory failure and reductions in ambulation. Currently, there is no pharmacological therapy for this condition. Studies indicate, however, that both beta-hydroxy-beta-methylbutyrate (HMB) and eicosapentaenoic acid (EPA) increase muscle function in patients with cancer and in older adults. The purpose of this study was to determine whether HMB and/or EPA administration would increase diaphragm and quadriceps strength in mechanically ventilated patients.
The application of an oxygen mask, without supplemental oxygen, improved oxygenation in patients with severe COVID-19 already treated with high-flow nasal cannula
Besarta Dogani, Fredrik M?nsson, Fredrik Resman, Hannes Hartman, Johan Tham & Gustav Torisson
doi : 10.1186/s13054-021-03738-8
Critical Care volume 25, Article number: 319 (2021)
Identification of distinct clinical phenotypes of acute respiratory distress syndrome with differential responses to treatment
Xiaowei Liu, Yusheng Jiang, Xiaonan Jia, Xiaohui Ma, Ci Han, Nana Guo, Yahui Peng, Haitao Liu, Yingnan Ju, Xiangfeng Luo, Xueting Li, Yue Bu, Jin Zhang, Yansong Liu, Yan Gao, Mingyan Zhao, Hongliang Wang, Ligang Luo, Kaijiang Yu & Changsong Wang
doi : 10.1186/s13054-021-03734-y
Critical Care volume 25, Article number: 320 (2021)
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome, and the identification of homogeneous subgroups and phenotypes is the first step toward precision critical care. We aimed to explore whether ARDS phenotypes can be identified using clinical data, are reproducible and are associated with clinical outcomes and treatment response.
Kinetics of blood neutrophil and lymphocyte count in critically ill neutropenic patients with hematological malignancies
Andry Van de Louw
doi : 10.1186/s13054-021-03740-0
Critical Care volume 25, Article number: 321 (2021)
Still a place for aortic counterpulsation in cardiac surgery and patients with cardiogenic shock?
Matthias Heringlake, Astrid Ellen Berggreen & Hauke Paarmann
doi : 10.1186/s13054-021-03673-8
Critical Care volume 25, Article number: 309 (2021)
Since its introduction into clinical practice in 1967 [1], the intra-aortic balloon pump (IABP) has played a prominent and steadily increasing role in cardiovascular medicine as the most frequently used mechanical circulatory support device. However, since the publication of a neutral Shock II trial on the effects of aortic counterpulsation in patients with myocardial infarction complicated by cardiogenic shock [2], use of this technology has decreased tremendously in many countries. It is of note that this decline has been observed not only in the field of cardiology—a finding that may easily be explained by guideline recommendations more or less prohibiting the use of an IABP in cardiogenic shock [3]—but also in cardiac surgery. In many European cardiac surgery centers, the IABP has been more or less completely substituted by other mechanical circulatory support modalities like the Impella® or—more frequently—by veno-arterial extracorporeal life support (ECLS) systems. Unfortunately, the clinical results with both technologies are more than disappointing and show an unacceptably high mortality rate [4,5,6]. This finding is in clear contrast to several meta-analyses [7, 8] highlighting the beneficial effects on clinical outcomes of preemptive use of an IABP in cardiac surgery and an increasing number of publications showing beneficial hemodynamic and outcome effects of the IABP in cardiogenic shock [9,10,11].
Measuring vitamin C in critically ill patients: clinical importance and practical difficulties—Is it time for a surrogate marker?
Sander Rozemeijer, Frans A. L. van der Horst & Angélique M. E. de Man
doi : 10.1186/s13054-021-03670-x
Critical Care volume 25, Article number: 310 (2021)
Interest in intravenous vitamin C administration has rapidly increased in the field of critical care medicine over recent years. The first studies investigating the effect of intravenous vitamin C in septic (shock) patients showed a decrease in organ dysfunction, vasopressor dependency, and even a reduction in mortality [1,2,3]. Within a short period of time, multiple trials in septic patients were conducted to confirm these promising findings, but results were not uniform [4,5,6,7,8,9,10,11,12]. The inconsistencies in effects on outcome may partially be explained by differences in study design [8], in particular the dosing regimens (timing, duration and dose) and choice of co-medication. For example, vitamin C administration has been investigated alone, or in combination with thiamine and/or hydrocortisone, sometimes with uncontrolled use of hydrocortisone in the control group. There is also considerable variety among septic patients as sepsis is a heterogeneous syndrome. Therefore, some subgroups of patients might benefit more than others from intravenous vitamin C therapy. A recently published meta-analysis on mortality performed subgroup analyses and found a beneficial effect of vitamin C on short-term mortality (<?30 days). Additionally, survival was improved by a treatment duration of 3–4 days [13]. The results of vitamin C alone versus combination therapy were not different. A particular subgroup of interest is patients with vitamin C deficiency. None of the studies performed subgroup analyses on vitamin C deficient patients. This is unfortunate, but understandable, since the measurement of plasma vitamin C concentration is difficult.
Advanced management of intermediate-high risk pulmonary embolism
Tatiana Weinstein, Himanshu Deshwal & Shari B. Brosnahan
doi : 10.1186/s13054-021-03679-2
Critical Care volume 25, Article number: 311 (2021)
Pulmonary embolism is extremely common both in the general public and in hospitalized patients, but patients who have intermediate-high risk pulmonary embolism continue to pose significant treatment dilemmas. This is because the short-term mortality of a pulmonary embolus ranges from 2% in normotensive patients, 30% in patients with right ventricular (RV) dysfunction, and up to 65% in patients with cardiac arrest on presentation [1].
Monitoring and modifying brain oxygenation in patients at risk of hypoxic ischaemic brain injury after cardiac arrest
Markus Benedikt Skrifvars, Mypinder Sekhon & Erik Anders ?neman
doi : 10.1186/s13054-021-03678-3
Critical Care volume 25, Article number: 312 (2021)
The majority of adverse clinical outcomes following successful resuscitation from cardiac arrest, are attributable to hypoxic ischemic brain injury [1]. The cornerstone of hypoxic ischemic brain injury management has traditionally focused on preventing secondary ischemic injury, following the return of spontaneous circulation (ROSC) [2]. Among the various mechanisms implicated in the pathophysiology of secondary injury, post-resuscitation cerebral ischemia is linked to central physiologic variables that may be modifiable [3]. Observational data demonstrate associations between perturbations in physiologic variables known to reduce cerebral blood flow (CBF)—such as arterial hypotension [4] and hypocapnia [5]—and adverse clinical outcome. This adds credence to the importance of optimizing cerebral oxygen delivery, to mitigate secondary ischemic injury. Recently, sentinel randomized controlled trials (RCTs) aimed at augmenting mean arterial pressure (MAP)—a key physiologic determinant of cerebral oxygen delivery—have yielded important insights into the importance of mitigating secondary cerebral ischemia [6, 7]. Although it did not establish a definitive link to improved neurological outcome, the COMACARE study demonstrated reduced levels of neurofilament light, a biomarker of brain injury, in patients undergoing an augmented MAP strategy following ROSC [8]. Patients may continue to experience episodes of brain hypoxia following cardiac arrest, despite goal-directed therapy and augmented MAP, with considerable heterogeneity in the underlying cerebrovascular hemodynamics in individual patients [9]. Thus, a targeted approach to the individualized management of hypoxic ischemic brain injury in the post-resuscitation phase requires the longitudinal monitoring of brain oxygenation—providing clinicians with real time physiologic data points to optimize cerebral oxygen delivery, similar to that applied in patients with traumatic brain injury (TBI) [10]. Near infrared spectroscopy (NIRS) provides an easily implemented and virtually complication-free way to monitor regional cerebral oxygen saturation (rSO2) in critically ill patients. The insertion of oxygen sensing catheters provides a real time assessment of the partial pressure of oxygen in brain tissue (PbtO2). This approach has gained widespread use following neurotrauma.
Acute kidney injury in ECMO patients
Marlies Ostermann & Nuttha Lumlertgul
doi : 10.1186/s13054-021-03676-5
Critical Care volume 25, Article number: 313 (2021)
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with severe respiratory and/or cardiovascular failure. There are two main configurations: (1) veno-arterial ECMO (VA-ECMO) in patients with refractory cardiogenic shock or combined cardiorespiratory failure, and (2) veno-venous ECMO (VV-ECMO) in patients with potentially reversible causes of respiratory failure. Over the past decade, use of ECMO has increased substantially in critical care units, emergency departments, interhospital transfers, operating rooms, and during cardiopulmonary resuscitation (CPR) [1].
Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy
Kosuke Yagi & Tomoko Fujii
doi : 10.1186/s13054-021-03677-4
Critical Care volume 25, Article number: 314 (2021)
Metabolic acidosis is a process caused by an increase in weak acids or a decrease in strong ion difference (SID) [1]. Serum proteins, albumin, and inorganic phosphate are considered as weak acids. Strong ions, such as Na+, K+, Ca2+, Mg2+, and Cl?, exist at a fully ionized status in body fluids. SID is the presence of an excess of strong cations over strong anions, and the normal value in plasma is 42 mEq/l. The method to quantify metabolic acidosis using SID and weak acids was introduced by Stewart in the 1980s and still creates debate in its clinical application [2]. Plasma base excess is widely used to identify a metabolic component of acidosis in clinical practice. The base excess approach was shown to be equivalent to Stewart’s SID approach in quantifying acid–base status in critically ill patients [3].
To prone or not to prone ARDS patients on ECMO
Oriol Roca, Andrés Pacheco & Marina Garc?a-de-Acilu
doi : 10.1186/s13054-021-03675-6
Critical Care volume 25, Article number: 315 (2021)
The prone position is recommended as a supportive therapy in patients with moderate- to-severe acute respiratory distress syndrome (ARDS). It is usually associated with improved oxygenation and pulmonary mechanics as the result of a more homogeneous distribution of mechanical forces and better ventilation/perfusion (V/Q) matching. These effects lead to a lower risk of aggravating preexisting lung injury and, ultimately, a decrease in mortality. Despite widespread use of the prone position in patients with ARDS, even in awake non-intubated spontaneously breathing patients, its use dramatically decreases once the patient has been placed on extracorporeal membrane oxygenation (ECMO). In this chapter, we discuss the available evidence regarding use of the prone position in ARDS patients treated with ECMO.
Tracheostomy for COVID-19: evolving best practice
Thomas Williams & Brendan A. McGrath
doi : 10.1186/s13054-021-03674-7
Critical Care volume 25, Article number: 316 (2021)
The global pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a dramatic impact upon all areas of healthcare, and this is no more evident than in critical care. Management of the critically ill evolved over time, with variability in admission criteria and the use of invasive ventilation reported from around the world and within individual countries [1]. However, the majority of patients admitted to intensive care units (ICUs) required advanced respiratory support [1], often for longer periods than expected when compared with historical viral pneumonias [2]. Tracheostomy is an entrenched element of modern critical care, with the dominant indication established as facilitating long-term ventilation and ‘weaning’ from respiratory support. Additional indications include actual or threatened upper airway obstruction, facilitating pulmonary clearance and to offer a degree of ‘protection’ against pulmonary aspiration. Prior to this pandemic, tracheostomy could be anticipated in 8–13% of patients receiving advanced respiratory support in modern ICUs [3]; usually temporary, but often in situ for several weeks (a median of 28 days in one recent UK-wide study) [4]. Reported rates of tracheostomies utilized during the coronavirus pandemic vary significantly from 16% to 61% [5, 6], but are certainly significantly higher than pre-pandemic rates.
Secondary infections in critically ill patients with COVID-19
Giacomo Grasselli, Emanuele Cattaneo & Gaetano Florio
doi : 10.1186/s13054-021-03672-9
Critical Care volume 25, Article number: 317 (2021)
Since December 2019, when the first case of human transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in Wuhan (China), more than a hundred million confirmed cases of coronavirus disease 2019 (COVID-19) have been described worldwide, and the pandemic declared on March 11, 2020 by the World Health Organization is still ongoing.
Pathophysiology and clinical implications of the veno-arterial PCO2 gap
Zied Ltaief, Antoine Guillaume Schneider & Lucas Liaudet
doi : 10.1186/s13054-021-03671-w
Critical Care volume 25, Article number: 318 (2021)
The persisting high mortality of circulatory shock highlights the need to search for sensitive early biomarkers to assess tissue perfusion and cellular oxygenation, which could provide important prognostic information and help guide resuscitation efforts. Although blood lactate and venous oxygen saturation (SvO2) are commonly used in this perspective, their usefulness remains hampered by several limitations. The veno-arterial difference in the partial pressure of carbon dioxide (Pv-aCO2 gap) has been increasingly recognized as a reliable tool to evaluate tissue perfusion and as a marker of poor outcome during circulatory shock, and it should therefore be part of an integrated clinical evaluation. In this chapter, we present the physiological and pathophysiological determinants of the Pv-aCO2 gap and review its implications in the clinical assessment of circulatory shock.
Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial
Peerapat Thanapongsatorn, Kamolthip Chaikomon, Nuttha Lumlertgul, Khanitha Yimsangyad, Akarathep Leewongworasingh, Win Kulvichit, Phatadon Sirivongrangson, Sadudee Peerapornratana, Weerachai Chaijamorn, Yingyos Avihingsanon & Nattachai Srisawat
doi : 10.1186/s13054-021-03747-7
Critical Care volume 25, Article number: 322 (2021)
Currently, there is a lack of evidence to guide optimal care for acute kidney injury (AKI) survivors. Therefore, post-discharge care by a multidisciplinary care team (MDCT) may improve these outcomes. This study aimed to demonstrate the outcomes of implementing comprehensive care by a MDCT in severe AKI survivors.
